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Risks and Benefits of Medicines for Heart Failure

Topic Overview

Heart failure is a very serious illness that can cause
life-threatening complications and significantly limit your life span.
Fortunately, many drugs have been shown to slow the progression of heart
failure, and several drugs have been shown to prolong survival. Each of these
medicines has risks and benefits that you and your doctor will need to weigh
when you are deciding whether you should take the medicine.

How do medicines relieve symptoms?

Medicines for
heart failure help relieve symptoms by:

Removing excess fluid from the body. The class
of medicines known as diuretics acts mainly to rid the body of excess
fluid.

Improving the ability of the heart to pump more
effectively. Another type of medicine, digoxin, works mainly by increasing
the strength of the contraction of the heart.

Preventing further
injury to the heart. A class of medicines known as angiotensin-converting
enzyme (ACE) inhibitors acts both by improving the efficiency of pumping and by
preventing further damage to the heart.

How do medicines prolong survival?

Several
medicines may help increase the life span of people who have
heart failure. These include:

ACE inhibitors.

ARBs (angiotensin
II receptor blockers).

Beta-blockers.

Aldosterone receptor antagonists, which are a type of diuretic. (Other types of diuretics can improve symptoms but do not improve
survival.)

The exact mechanism by which these medicines prolong
survival is not entirely clear. Each medicine might have several beneficial
effects for people with heart failure. In terms of prolonging survival, the
most important effects may be the ability of these drugs to prevent both lethal
abnormal heart rhythms and their ability to limit ongoing damage to the
heart.

Benefits and risks of heart failure drugs

Drug or class of drugs

Benefits

Risks

ACE inhibitors

Inhibit adverse effects of angiotensin
II on the heart and blood vessels

Reduce heart failure
symptoms

Prolong survival

Low blood pressure

Soft
tissue swelling of the face and throat, and hives (severe allergy)

Dry cough

Reduced kidney function

Increased
potassium

Beta-blockers

Reduce heart failure symptoms

Prolong survival

Prevent ventricular
arrhythmia

Slow heart rate improves diastolic heart
failure.

Heart rate too slow

Diuretics

Reduce fluid buildup in the lungs and
legs

Reduce heart failure symptoms

Prolong survival
(aldosterone receptor antagonists)

Low blood pressure

Reduced
kidney function if too much fluid removed

Low or high potassium,
magnesium, calcium

Digoxin

Decreased heart failure
symptoms

Reduced need for
hospitalization

Heart rate too slow

Dangerous arrhythmias if level too high

Calcium channel blockers

Help your heart fill with blood more easily.

Slow heart rate

Constipation or diarrhea

Dizziness or lightheadedness

Flushing or feeling warm

Angiotensin II receptor blockers (ARBs)

Inhibit adverse effects of angiotensin
II on the heart and blood vessels

Reduce heart failure symptoms

Prolong survival

Low blood pressure

High potassium

Hydralazine

Vasodilatation

Reduce heart
failure symptoms

Reduce heart
failure symptoms and lower risk of early death when used in combination with a nitrate

Low blood pressure

Nitrates

Relieve angina (chest pain or discomfort)

Reduce heart
failure symptoms and lower risk of early death when used in combination with hydralazine

Low blood pressure

Headache

Tailor the decisions you make with your doctor to meet your own personal goals of treatment for your heart failure. Some
decisions are not always completely right or wrong. What is most important is
that you make informed decisions that are right for you and with which you are
comfortable.

In fact, your goals of treatment may change over
time. Early in the course of your treatment, you may want to do everything
possible to extend your life span, even if it means making your symptoms
temporarily worse. A good example of this is starting therapy with a
beta-blocker, which can make your symptoms worse during the first few weeks or
months but eventually may reduce your symptoms and prolong your survival.

But if you develop end-stage heart failure with very severe
symptoms that prevent you from doing even simple activities, you may prefer
treatments that are most effective at reducing your symptoms, even if they may
have some risk of decreasing your survival.

To help you with decision making, the most important things you can do
are: first, keep yourself well informed about the risks and benefits of the
treatments that are available to you, and second, work closely with a doctor whose advice and opinions you trust.

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How this information was developed to help you make better health decisions.